Provider Demographics
NPI:1477243368
Name:EVO SOLUTIONS YOUTH&FAMILY SERVICES
Entity Type:Organization
Organization Name:EVO SOLUTIONS YOUTH&FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENEAPHA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-706-3020
Mailing Address - Street 1:1216 E VISTA DEL CERRO DR APT 1131
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-7101
Mailing Address - Country:US
Mailing Address - Phone:602-706-3020
Mailing Address - Fax:
Practice Address - Street 1:731 E WESLEYAN DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3844
Practice Address - Country:US
Practice Address - Phone:602-706-3020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty